Welcome! My name is Diana Shenefield. And on this lecture,
we’re going to talk about non-pharmacological
comfort interventions. You know, sometimes
as nurses, the easy thing to do is to go get
that pain med for our patients. But we have
to remember that a lot of times, pain meds
don’t always take care of the problem. So,
let’s look at some ways that we can help
our patient without just giving them a pill.
So we’re going to look at what are our options.
Sometimes as nurses, again, we look at what
medically we can do. But we need to remember
that we’re holistic, and there's a lot
of things we can do to comfort our patients
without giving them medications. So, let’s
look at those and be thinking about those
in your mind. And it’s not necessarily things
that you maybe do personally, but maybe you
have a resources, or maybe there’s somebody
in their family that knows these interventions
and can help the patient. There are a lot
of things that I don’t know how to do.
I don’t know how to do acupuncture. But I
do understand that acupuncture does help a
lot with pain relief for certain illnesses.
So, maybe it’s not me that’s doing it,
but maybe it’s helping the patient find
resources that will work for them. So, what
are we going to look at? We’re going to
look at assessing our patients, and we’re
not only going to look at our patients that
we have that are acute, but we’re also going
to look at palliative care. We know that people
that are in palliative care sometimes have
a lot of discomfort, maybe not just pain but
restlessness, nausea, all of those other things,
itching. So, what can I do to help those symptoms
without necessarily giving medications?
And then what is the assessing the need for pain?
We’ve talked earlier about, sometimes people
won’t tell us they’re in pain and we have to
pick up on certain clues. But again, sometimes,
medication isn’t always the answer. Sometimes,
dealing with somebody spiritually or emotionally
or helping them deal with their cultural differences,
sometimes helps with the pain because it eases
the mind. Again, when you have your patient,
do a good assessment and make sure that you’re
looking at all aspects of what could help
that patient feel better.
So, here’s our practice question. We have
a patient who has got chronic back pain, and
think about all of the people that you know
with chronic back pain, and they ask the nurse
about alternative therapies. Sometimes people
use their alternative therapies, complimentary
therapies. Again, whatever the terminology
is, we’re looking at ways to help our patients
without giving them medications. And this
patient also wants to also keep up with their traditional
medicine. Again, a lot of times, people, when
they’re asking about alternative medicine,
they’re not saying that they don’t want
any medical help. They’re just saying, “Is
there something else that we can do? Is there
something else besides medicine that might
help them feel better?” So which of
the following forms of alternative
therapy could the nurse provide for this patient?
A, music therapy or guided imagery; B, acupuncture;
C, Kegel exercises; or D, none. Nurses don’t
participate in providing alternative treatments.
Hopefully, you didn’t pick D, because we
do. That is a lot of what we do. And if you
think about all the times that you’re caring
for your patient, when you’re laying hands
on your patient or you’re talking to your
patient, you are providing alternative therapy.
So the answer to this question is A, music
therapy and guided imagery.
Again, acupuncture is a good choice, but as
a nurse, that’s not what I do. I can help
people find, maybe, resources but I don’t
do that. And then Kegel exercises, that isn’t
going to help somebody with a low backache.
So again, looking at what are your options
and what are things that you can do, and music
therapy definitely. A lot of times, people
will ask, “You know, do you have any music?
Is there TV stations that have music?”
Encourage patients to bring in their iPads
or their music so that they can listen to
it. It’s very soothing. So, what can you
do as a nurse besides just giving medications?
So, you want to review heat therapy, and you
want to review cold therapy, and when would
you suggest to a patient when to use which?
We know heat therapy decreases muscle spasms.
We put heat on people when they’ve had a
sprain or something that’s just causing
a lot of aching. We also know that ice works
well to decrease swelling. And if you can
decrease swelling and decrease muscle spasms,
you get a better result from your pain therapy
with the medication as well. And then don’t
forget RICE. You can’t ever forget RICE,
your rest, ice, compression, and elevation.
Again, none of that involves medication, but
those are all things to decrease swelling
that will help with pain relief.
What about massage? Just rubbing somebody’s
back or rubbing their legs can make a huge
difference in pain relief. So don’t forget
about your hands-on care of your patient.
It’s not just for assessing but it’s also
for comfort. TENS units, those are always
available. Again, maybe through a pain specialist
or a pain nurse, but again, don’t forget
that there is electrical stimulation that
can help, maybe for your patient that has
chronic lower back pain. Spinal cord stimulation.
Again, as a nurse, I’m not going to participate
in that, but my patients may go to surgery
or they may see a pain specialist that will
help with that to eliminate some of that pain.
And then aromatherapy and essential oils.
Essential oils are making a big comeback again.
So, what is it about aromatherapy that comforts
and what smells? Again, in the hospital, we
can’t light candles, but maybe there's
little oils that the patient can put on their
wrist and smell just to help comfort them
and to ease them, whether it’s their mood,
whether it’s their stress. We all know that
that combines with pain. With a patient that’s
very stressed and sleep-deprived, their pain
is a lot worse. So, maybe just bringing their
stress down and helping them relax is going
to help with their pain relief too. And then
music. Again, many patients enjoy
all different kinds of music. And so sometimes
just a calming music would help bring their
stress down as well, and then subsequently,
get rid of their pain or their nausea, itching.
It just kind of gets their mind off of it.
Biofeedback, self-hypnosis, again, all things
that pain therapists, pain physicians are
trained in, they can help your patient maybe
on the long-term, patients with chronic problems.
They don’t have to suffer. They don’t
have to take lots of our NSAIDs that we know
causes gastric bleeding.
So again, what can we do so that the patient
doesn’t have to take as much medication?
Laughter. Laughter is huge, just getting patients
to laugh. And the old adage that laughter
is the best medicine has been proven over
and over again, that using humor helps our
patients. It gets their minds off of their
pain or their discomfort. And then guided
imagery. Again, nobody is going to probably
say, “You can’t be a nurse because you
can’t do guided imagery.” But what they’re
looking for on NCLEX is that, “Do you understand
that there are other ways to comfort your
patient besides giving medications?”
So as you’re reading your questions and
it’s talking about pain or discomfort, don’t
automatically jump to the answer that talks
about giving morphine or Dilaudid. Look at
your patient and what kind of pain they’re
in and what other kind of situations that
they’re in. And is there a better answer
to your question that maybe
would work better than maybe a morphine or
a Dilaudid? Palliative care. When we talk
about palliative care, we talk about pain. We
talk about nausea, vomiting, itching, anxiety,
restlessness. Again, when we talk
comfort, it’s not always just pain. It can
be restlessness. You have your Alzheimer’s
patient that’s restless, and you know, we
don’t want to just tie them to the bed or
combine them to a room, but what can we do
maybe to lower their anxiety, lower their
restlessness in a more natural way so that
we’re not sedating them all of the time.
Lot of your patients with dementia or sundowners,
again, we know it’s going to happen.
So, what can I do proactively? What can I be prepared
to do to just lower those symptoms so that
my patient can rest, and also eliminate the
risk for falls?
So in closing again, don’t always jump to
medication, but use your critical thinking,
use your problem solving skills, and see if
there's other ways that you have available
to you, or resources that you have available
to you, that you can help your patient and
comfort them without always going to your
medication cabinet. Good luck on NCLEX.